Principles of Topical Treatments in Dermatology Doç. Dr.

Principles of Topical Treatments in Dermatology Doç. Dr.Burhan Engin

The skin has a surface area of 1.6-2 m2 This area enables the enhancement of systemic treatment measures An extensive region for the application and absorption of topical medications The active ingredients penetrate the skin either via transepidermal or transfollicular pathways

What are the parameters that should be considered for cutaneous drug administration Age of patient Area of the body Pathologic changes in the skin Hydration of stratum corneum and skin temperature Vascular supply Role of vehicle

What are dermatologic vehicles? Powder Paste Shake lotion Ointment Hydrophilic ointment, cream or lotion Water

When do we use topical treatment? If a patient has a skin disorder covering < 30% of body, the topical medication may be considered.

Choice of vehicles Three main determinants to choose the right vehicle are: Patient’s skin type Degree of acuity of the disease Nature of the lesions

Choice of vehicles Skin type: About 50% of individuals have oily skin or seborrhea. They do better with creams, lotions, or shake lotions while the ones with dry skin do better with ointments or pastes. Degree of acuity: Acute inflammatory processes are best treted with creams or lotions. If the lesions are weeping, shake lotions are fine.

Choice of vehicles for different lesions Lesion Recommended Avoided Acute erythema shake lotion, Ointment, lotion, cream paste Vesicles shake lotion, Paste, gel, lotion ointment Blisters Wet dressings, Paste, shake lotions ointment, powder Erosions Wet dressings, powder, ointment shake lotion Crusts Ointment, wet dr. Powder, gel Ch. inflammation Ointment

Topical agents Keratolytic agents Cytotatic agents: Podophyllin, 5-fluorouracil Retinoids Antibiotics, antifungals, antiviral agents Corticosteroids Combination products Tacrolimus, pimecrolimus Nonsteroidal antiinflammatory agents Sunscreens

Topical corticosteroids Class I (weakest): Hydrocortisone, prednisolone Class II: Methylprednisolone aceponate, triamcinolone Class III: Betamethasone 17-valerate Class IV (strongest): Clobetasol 17-propionate

Side effects of topical corticosteroids Epidermis : Atrophy Hair follicles: Steroid acne Dermis: Atrophy, striae Pigmentation: Hypopigmentation Vessels: Erythema, telangiectases

What would you prescribe for: An infant having flares of erythema and small papules on the cheeks An infant having severe erythema and mild scaling involving the convexities of the buttocks A female adult having mild erythema, scales and fissures on the fingertips and volar aspect of her hands

What would you prescribe for: A burn (with hot water) involving the wrist, with erythema and blisters A clinical picture with vesicles, yellow ccrusts and oozing erosions Hyperkeratotic plaque with scales, prominent skin markings and severe pruritus